title: Reduction mammaplasty and resource allocation--are patients being treated fairly? An examination of the current New Zealand situation, and looking towards the future.
abstract: OBJECTIVE
  To review the access to publically-funded reduction mammaplasty for New Zealand (NZ) women. Additionally, to evaluate quality of life gains from reduction mammaplasty and other surgical treatments of chronic conditions. Ultimately to determine whether access to surgical treatment for this condition is equitable.
  
  
  METHODS
  Four tertiary referral centres for Plastic Surgery in NZ completed a survey to characterise patient access. A literature search was done to investigate the global situation and obtain quality of life information following breast reduction and other operations for chronic conditions.
  
  
  RESULTS
  The survey showed there was significant inequity in allocation and access to breast reduction surgery in NZ over time and geographical location. There were hopes that the Ministry of Health Prioritisation Tool would ensure more equitable access to plastic surgical procedures nationally in the future. A similar situation exists in Europe in regards to allocation, and insurance companies dictate access in the US. There was overwhelming evidence to support quality of life gains with reduction mammaplasty, which are equal to if not greater than more accessible operations.
  
  
  CONCLUSIONS
  In NZ there is inequitable access to surgery for patients who would be treated by breast reduction surgery, with substantial variation across geography and time. A new Prioritisation Tool may address this discrepancy. Much evidence exists that quality of life gains for reduction mammaplasty are equivalent to other surgical procedures, which are more readily available. The challenge is to improve equity of access across all surgical conditions.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.
authors.forename: Eloise E
authors.initials: EE
authors.lastname: Dickie
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Simcock
mesh_terms: D000465:Algorithms; D001940:Breast / Q000002:abnormalities / Q000601:surgery; D005260:Female; D005380:Financing, Government; D015276:Health Care Rationing; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D006984:Hypertrophy / Q000601:surgery*; D016462:Mammaplasty / Q000191:economics / Q000523:psychology; D009313:National Health Programs; D009520:New Zealand; D018579:Patient Selection; D011788:Quality of Life / Q000523:psychology; D012017:Referral and Consultation; D040841:Resource Allocation